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DocuSign Envelope ID: 3289A281-EC13-40C5-A56D-BE1F23756321 North Carolina Department of Health and Human Services AGED, BLIND AND DISABLED MEDICAID MANUAL MA-1000 5

SSI MEDICAID – AUTOMATED PROCESS

(III.) E. Reporting Changes

1. SSI recipients must report to Social Security all changes that affect SSI (including change of address). When Social Security updates the SDX, the change is reflected in EIS. If an SSI recipient reports a change to the dss, instruct him to report the change to the local Social Security Office. Explain that his Medicaid record can only be changed by SSA. Give him the address and phone number of the district office. DO NOT REPORT ROUTINE CHANGES TO SOCIAL SECURITY. IT IS THE RECIPIENT'S RESPONSIBILITY.

2. SSI recipients in LTC, SAD, SAA, HSF, or AAF payment type 5 (situations where the county dss has the capability to update some fields in EIS) must also report changes that affect Medicaid to the county dss. When changes are reported, treat this as change in situation. Update the allowable fields in EIS.

3. When an SSI recipient reports health insurance information to the dss, complete a DMA-2041, Third Party Health and Accident Resources Information. Enter this information in EIS. If the recipient does not have enough information to enable you to complete the DMA-2041, instruct him to obtain the additional information and advise him to contact you with the information as soon as possible.

4. When an SSI recipient also receives Food Stamps or other DSS services, notify the other program immediately of any changes the recipient reports to you.

5. When the dss learns of a change in an SSI Medicaid recipient's situation that might affect his eligibility for SSI and Medicaid, and the client does not/cannot report the change to SSA, use the DMA-5049, Referral to the Local Social Security Office, to report information to the local SSA office. Use this referral only when SSA is not aware of the change in situation. Examples of when to use this referral:

a. DSS learns SSI recipient dies

b. SSI recipient enters a public institution, nursing facility, or rest home

c. DSS learns information that affects SSI payment

d. DSS suspects fraud

6. The county dss may discover information on the SDX is incorrect. The information may not affect SSI eligibility, but it may cause a problem with Medicaid claims, buy-in or some other factor that affects Medicaid eligibility. Use the DMA-5049, Referral to the Local Social Security Office, to report this information immediately to SSA. Use "Other" to specify the problem. SSA must correct its record in order for the SDX to update EIS. For example, the dss verifies an individual is age 64 or less, but the SDX indicates he is 65. Medicaid claims will be denied until the problem is corrected.